Post on 20-Jun-2020
transcript
2018 SD Annual Trauma
Symposium :
Never Stop Improving: The
Importance of Nurse and
Physician Competencies
Lacey Kessler, MD, Family Medicine
Medical Director for Bowdle HealthCare Center
Disclosures:
I have nothing to disclose
OutLine
Power of Teamwork: Studies
Bowdle HealthCare Center
Trauma Performance Improvement
Maintaining Skills Competencies
Studies on Teamwork
“Trauma patients benefit from resuscitation by a trauma team
because of the rapid resuscitation and stabilization and reduction
in time to diagnostics and treatment. The team leader must oversee
the resuscitation and intervene when necessary. Leadership skills
have shown to be of particular importance.”
“Simulation training of teams improves performance but must be
repeated on a regular basis if the effect is to be sustained.”
Studies on Teamwork
“The rapid development of trauma services has not been universal
despite the high mortality rates ... Mortality reduction requires a
comprehensive performance improvement program and an
effectively performing trauma team is one contributing feature of
good system performance…the trauma team has been
independently shown to reduce time in the resuscitation room, time
to key investigations and to definitive care and reduce the rate of
missed injury…If well audited, further reductions in mortality should
be anticipated by education and by the introduction of processes
to improve the workings of the team.”
Bowdle: Population ~500-600
Bowdle HealthCare Center
Hospital: 2 bay ER, 1 Procedure RM, 12 Beds
Providers: 2
Nursing: Typically 2 Floor Nurses and 1 CNA
Trauma Performance Review
INCLUDE EVERYONE THAT IS INVOLVED IN THE TRAUMA CODE
This starts at the scene: EMS and First Responders
Hospital Staff: RNs, Lab, Radiology, Providers, Support Staff
Trauma Coordinator, Trauma Medical Director, Administration
Trauma Performance Review
Monthly meetings to review trauma cases with all team members
Opportunity for all team members to review what when well and
what could be improved
Considered peer review, confidential, and non-discoverable
Trauma Performance Review
Dissecting the provider notes and nursing notes/charting and
compiling an easy to read time line for each case with particular
reference to filters
Trauma Performance Improvement:
EMS Pre-Hospital Filters
EMS trip ticket in patient’s chart?
Scene time greater than 20 minutes?
Appropriate airway maintenance?
Trauma Performance Improvement:
EMS Pre-Hospital Filters
Appropriate Spinal Immobilization (back board/cervical collar)?
Patient met physiological and/or anatomical absolute criteria?
Trauma Team requested by EMS?
If Trauma Team requested by EMS, did EMS document this in trip
ticket?
Trauma Performance Improvement:
E-Emergency Filters
Was E-Emergency Used?
If used, is form present in the chart?
Is form signed by provider?
Is form signed by RN?
Trauma Performance Improvement:
BHC Filters
Patient met physiological and/or absolute criteria?
Was trauma team activated by hospital personnel?
Did trauma team members arrive within 20 minutes?
Provider, Lab, Radiology
Trauma Performance Improvement:
BHC Filters
Patient transferred with ER length of greater than 2 hours?
GCS less than 8 and airway established?
Compete vital sign documentation including temperature and GCS
(minimum of 2 times)?
Trauma Performance Improvement:
BHC Filters
Required and appropriate sized equipment available?
Warming measures documented?
Back board removal documented and removed in less than 20
minutes?
C-Collar application and removal times documented?
Trauma Performance Improvement:
BHC Filters
Large bore IVs used?
Decision to transfer time documented by provider (less than 15
minutes goal)?
CT chest ordered without portable chest x-ray?
Trauma Performance Improvement:
BHC Filters
CT chest/abdomen/pelvis ordered without contrast?
Hemo/Pneumothorax diagnosed and no chest tube placed?
Greater than 3 liters of crystalloid IV fluids given (including EMS) and
blood products not used?
Trauma Performance Improvement:
BHC Filters
CT done on a pediatric patient under age 16?
If trauma death, was an autopsy requested or performed?
Skills Competency
All members of the trauma team encouraged to attend
Teaching environment
Comfortable/Informal
Hands on practice
Questions welcome
Skills Competency
Lead by trauma coordinator and trauma medical
director/providers
Set up into two stations: each one hour
Skills Competency
Station 1
RSI
Medications, dosing, administration sequence
Airway
Suction, securing ETT, airway adjuncts
LUCAS
Crash Cart Review
Chest Tubes
Location of supplies, drainage/collecting system set up
Suction set up
Skills Competency
Station 2
I/O insertion
Splinting
application of c-collar, back board, limb immobilization, log roll
Tourniquet and pelvic binder
Trauma information and documentation
Trauma team activation criteria, PI indicators, trauma registry
Trauma Resource manual
Use of E-Emergency
Telemed setup
Skills Competency
Feedback from participants
What did they like or would like to see changed
Feedback was excellent
Staff enjoyed the hands on practice
Preference for case based scenarios
THANK YOU
Kirby Kleffman, RN, Trauma Coordinator
All the staff at Bowdle HealthCare Center
Any Questions?
References:
Images: CityData.com, AberdeenNews.com, k12.sd.us
Groenestege-Kreb D. Tiel , O. van Maarseveen, and L. Leenen; Trauma Team, British
Journal of Anaesthesia 113(2): 258–65(2014). 30 June 2014 .
Georgiou, Andrew and Lockey, David; The performance and assessment of hospital
trauma teams, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
2010: 18: 66, 13 December 2010.